Decreased Diastolic Ventricular Kinetic Energy in Young Patients with Fontan Circulation Demonstrated by Four-Dimensional Cardiac Magnetic Resonance Imaging

Sjöberg, Pia; Heiberg, Einar; Wingren, Pär; Johansson, Jesper; Malm, Torsten; Arheden, Håkan; Liuba, Petru; Carlsson, Marcus

doi:10.1007/s00246-016-1565-6

Cited by 32 publications

(33 citation statements)

References 37 publications

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“…Since kinetic energy reflects ventricular performance, it could potentially be a novel and advanced method for evaluation of the cardiac function 19. Intracardiac kinetic energy has been shown to be abnormal in patients with ToF, Fontan circulation, mitral regurgitation and heart failure 20…”

Section: D-flow Cmrmentioning

confidence: 99%

Three-dimensional and four-dimensional flow assessment in congenital heart disease

Warmerdam

Krings

Leiner

et al. 2019

Heart

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Congenital heart disease (CHD) is the most common form of congenital defects, with an incidence of 8 per 1000 births. Due to major advances in diagnostics, perioperative care and surgical techniques, the survival rate of patients with CHD has improved dramatically. Conversely, although 70%–95% of infants with CHD survive into adulthood, the rate of long-term morbidity, which often requires (repeat) intervention, has increased. Recently, the role of altered haemodynamics in cardiac development and CHD has become a subject of interest. Patients with CHD often have abnormal blood flow patterns, either due to the primary cardiac defect or as a consequence of the surgical intervention(s). Research suggests that these abnormal blood flow patterns may contribute to diminished cardiac and vascular function. Serial assessment of haemodynamic parameters in patients with CHD may allow for improved understanding of the often complex haemodynamics in these patients and thereby potentially guide the timing and nature of interventions with the aim of preventing progression of cardiovascular deterioration. In this article we will discuss two novel non-invasive four-dimensional (4D) techniques to evaluate cardiovascular haemodynamics: 4D-flow cardiac magnetic resonance and computational fluid dynamics. This review focuses on the additional value of these two modalities in the evaluation of patients with CHD with abnormal flow patterns, who could benefit from advanced haemodynamic evaluation: patients with coarctation of the aorta, bicuspid aortic valve, tetralogy of Fallot and patients after Fontan palliation.

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Section: D-flow Cmrmentioning

confidence: 99%

Three-dimensional and four-dimensional flow assessment in congenital heart disease

Warmerdam

Krings

Leiner

et al. 2019

Heart

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“…In this latter study, the increase of kinetic energy is explained by a 50% decrease of the combined crosssectional area of the SVC and IVC compared with the PAs. 95 It should be noted that kinetic energy is only part of the energy equation (Appendix I in the online-only Data Supplement) and does not represent total energy loss. Although 4D flow MRI is a promising noninvasive technique that can be easily implemented in clinical care, spatial resolution (ie, the size of the voxels in mm 3 ) is a major issue because this has been shown to be the limiting factor in accurately calculating energy loss (Appendix I in the online-only Data Supplement).…”

Section: D Flow Mri Studiesmentioning

confidence: 99%

Energetics of Blood Flow in Cardiovascular Disease

Rijnberg¹,

Hazekamp²,

Wentzel

et al. 2018

Circulation

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Visualization and quantification of the adverse effects of distorted blood flow are important emerging fields in cardiology. Abnormal blood flow patterns can be seen in various cardiovascular diseases and are associated with increased energy loss. These adverse energetics can be measured and quantified using 3-dimensional blood flow data, derived from computational fluid dynamics and 4-dimensional flow magnetic resonance imaging, and provide new, promising hemodynamic markers. In patients with palliated single-ventricular heart defects, the Fontan circulation passively directs systemic venous return to the pulmonary circulation in the absence of a functional subpulmonary ventricle. Therefore, the Fontan circulation is highly dependent on favorable flow and energetics, and minimal energy loss is of great importance. A focus on reducing energy loss led to the introduction of the total cavopulmonary connection (TCPC) as an alternative to the classical Fontan connection. Subsequently, many studies have investigated energy loss in the TCPC, and energy-saving geometric factors have been implemented in clinical care. Great advances have been made in computational fluid dynamics modeling and can now be done in 3-dimensional patient-specific models with increasingly accurate boundary conditions. Furthermore, the implementation of 4-dimensional flow magnetic resonance imaging is promising and can be of complementary value to these models. Recently, correlations between energy loss in the TCPC and cardiac parameters and exercise intolerance have been reported. Furthermore, efficiency of blood flow through the TCPC is highly variable, and inefficient blood flow is of clinical importance by reducing cardiac output and increasing central venous pressure, thereby increasing the risk of experiencing the well-known Fontan complications. Energy loss in the TCPC will be an important new hemodynamic parameter in addition to other well-known risk factors such as pulmonary vascular resistance and can possibly be improved by patient-specific surgical design. This article describes the theoretical background of mechanical energy of blood flow in the cardiovascular system and the methods of calculating energy loss, and it gives an overview of geometric factors associated with energy efficiency in the TCPC and its implications on clinical outcome. Furthermore, the role of 4-dimensional flow magnetic resonance imaging and areas of future research are discussed.

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“…For example, one study found decreased diastolic kinetic energy (KE) in patients with Fontan circulation compared with controls. 8 However, further study is needed because multiple studies have shown that KE is often higher in the ventricle or atria of patients with heart disease than in healthy controls.…”

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confidence: 99%

Analysis of cavopulmonary and cardiac flow characteristics in fontan Patients: Comparison with healthy volunteers

Rutkowski

Barton

François

et al. 2019

Magnetic Resonance Imaging

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Background Characterizing the flow of the Fontan circuit, and correlating flow characteristics with the development of complications, is an important clinical challenge. Past work has analyzed the flow characteristics of Fontan circulation on a component‐by‐component basis. 4D flow MRI with radial projections allows for large volumetric coverage, and therefore can be used to analyze the flow through many codependent cardiovascular components in a single imaging session. Purpose To describe flow characteristics across the entire Fontan circuit and to compare these with the flow characteristics in healthy volunteers. Study Type Prospective. Subjects Eleven single ventricle patients with a Fontan connection and 15 healthy controls. Sequence Phase contrast with vastly undersampled isotropic projection reconstruction (PC‐VIPR) at a field strength of 3 T. Assessment Cavopulmonary and ventricular flow distributions, blood flow kinetic energy, vorticities, efficiency indices, and other flow parameters were analyzed using Ensight and MatLab. Statistical Tests The results were compared across Fontan subjects, between respiratory phases, and between Fontan subjects and healthy volunteers using a Student's t‐test for unequal sample sizes and linear regression. Results Cava‐specific pulmonary flow distributions of Fontan patients varied significantly between respiratory phases (P < 0.05). Ventricular kinetic energy (KE) was significantly higher in Fontan patients than it was in healthy controls, leading to a lower cardiac efficiency metric in the Fontan group. A significant diastolic KE time‐shift was also observed in the Fontan patient group. Peak diastolic KE was significantly higher in the single ventricle of patients with right ventricle morphology than it was in left ventricle morphology patients. Data Conclusion Radial 4D flow MRI can be used for comprehensive analysis of single ventricle Fontan flow characteristics. Level of Evidence: 2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019.

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Decreased Diastolic Ventricular Kinetic Energy in Young Patients with Fontan Circulation Demonstrated by Four-Dimensional Cardiac Magnetic Resonance Imaging

Cited by 32 publications

References 37 publications

Three-dimensional and four-dimensional flow assessment in congenital heart disease

Three-dimensional and four-dimensional flow assessment in congenital heart disease

Energetics of Blood Flow in Cardiovascular Disease

Analysis of cavopulmonary and cardiac flow characteristics in fontan Patients: Comparison with healthy volunteers

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